Answers many questions regarding Florida Workers Compensation reimbursement
Q. How long does a workers’ compensation insurer have after the receipt of a medical bill to respond to the provider?
A. A workers’ compensation insurer is required by statute to pay, disallow, or deny reimbursement of an accurately completed medical bill within 45 days of receipt. Additionally, the insurer shall provide written notification of the reimbursement decision (Explanation of Bill Review, EOBR) to the provider, pursuant to Rule 69L-7.602, F.A.C.
Q. What happens if the workers’ compensation insurer denies the payment of services previously authorized by either the employer or insurer, or rendered as emergency treatment at the request of the employer?
A. If the provider bills for rendered services, authorized by the employer or workers’ compensation insurer or rendered as emergency treatment, and the insurer determines that the condition for which the services were rendered is not covered under the Florida Workers’ Compensation system, the insurer is responsible for reimbursing the provider for such services until the insurer issues a Notice of Denial to the provider and all interested parties on the Form DFS-F2-DWC-12, informing the provider that further treatment is not authorized and is not reimbursable, s.440.20 (4) F.S.